WHO Alliance for Patient Safety Hand Hygiene Survey Results from Phase One October 2007 In March 2007 the First Global Patient Safety Challenge of the World Alliance for Patient Safety, in collaboration with the Patients for Patient Safety Programme and Dr. Maryanne McGuckin, USA, initiated an international survey on Hand Hygiene to determine: The availability of hand hygiene products (soap and water and/or alcohol-based handrubs.) The extent of patient empowerment in hand hygiene. What programmes exist within respondent s countries and communities to promote hand hygiene and infection control, and what approaches were considered most useful to educate people in regard to hand hygiene. Personal experiences of health-care associated infections. The survey was made available through a link on the World Health Organisation website and was distributed by Patient Safety Champions throughout the world to people within their communities. This report presents the findings from the 238 respondents, from 43 different countries, who completed the survey between March and August 2007. The analysis is presented for the total data set, and is then subdivided by region, and by whether respondents identified themselves as healthcare workers. A second survey will commence in vember 2007 (Phase 2), and will encompass: The collection of further responses to the survey, with an effort to contact a greater proportion of people who are not healthcare workers or healthcare policy makers, and who are from countries outside rth America or Europe. Qualitative Research will be undertaken, conducting interviews with respondents who have stated that they know a person who contracted an infection while they were in hospital, after surgery, or visiting a clinic, office or other healthcare facility. Page 1 of 18
Summary Analysis Availability of Hand Hygiene Products Table 1: Availability of Hand Hygiene products Sometimes Are hand cleaning products (e.g. soap, water or alcoholbased handrubs) readily available for staff, patients, and visitors to use in your hospitals and clinics? Response 74% 4% 19% 4% Patient Empowerment Table 2: Patient Experiences of patient empowerment Response Have you ever asked your healthcare worker to wash/sanitize their hands before they examined you? 33.5% 66% 0.5% Those who answered yes to this question were asked what response they received from their healthcare worker: Graph 1: When you asked your healthcare worker to wash/sanitize their hands, what response(s) did you receive? Percentage of the number of people who asked their healthcare worker to wash/sanitise their hands 10 7 6 5 4 2 They washed/sanitized their hands They said this was not necessary because they wear gloves They said they washed/sanitized before coming to you They were angry at you for asking They refused to wash/sanitize their hands Other Graph 1 shows that, of the 80 people who asked their healthcare worker to sanitize their hands, in 69% of cases, healthcare workers proceeded to sanitize their hands. Thirty-one percent of respondents reported that their healthcare worker became angry, and 9% reported that their healthcare worker refused to wash or sanitize their hands. Page 2 of 18
Respondents were asked a set of hypothetical questions on patient empowerment on hand hygiene issues: Table 3: Patient expectations in hypothetical situations If your doctor, nurse, or other person providing healthcare to you, ASKED or invited you to remind them to wash their hands before examining you would you feel able to do this? Response 84% 14% 2% If your doctor, nurse, or other person providing healthcare to you, DID NOT ASK or invite you to remind them to wash their hands before examining you would you feel able to do this? If you saw a doctor or nurse taking care of the patient next to you and then coming to you without washing or sanitizing their hands, would you ask them to do so? 56% 41% 3% 76% 21% 3% Table 3 illustrates that 56 percent of respondents expected that they would feel able to remind their healthcare provider to wash their hands if they had not been asked to do so, but this increased to 84 percent if they had been ASKED or invited to do so. Table 3 also suggests that where patients can see that their healthcare worker had not complied with hand hygiene they feel more empowered to question their healthcare worker. Explanations of the reasons(s) for not feeling able to remind their healthcare worker to sanitize their hands indicated a range of possible explanations. Graph 2: If you would not feel able to remind your healthcare worker to wash/sanitize their hands if they had ASKED or invited you to do so, please indicate your reason(s) why. 20 18 16 Number of respondents 14 12 10 8 6 4 2 0 Fear Shyness Feelings of being disrespectful Cultural barriers Such an approach should not be necessary Other Page 3 of 18
Graph 3: If you would not feel able to remind your healthcare worker to wash/sanitize their hands if they HAD NOT ASKED or invited you to do so, please indicate your reason(s) why. 70 60 Number of respondents 50 40 30 20 10 0 Fear Shyness Feelings of being disrespectful Cultural Barriers Page 4 of 18
Hand Hygiene Programmes When asked whether there were Hand Hygiene programmes in their Country or Community respondents answered: Error! t a valid link. Respondents selected the following approaches as the best ways to educate people in their Country or Community on the importance of hand hygiene and infection control: Graph 5: What would be the best way(s) to get messages across to educate people in your Country/Community about hand hygiene and how to prevent infection? 250 200 Number of respondents 150 100 50 0 Through healthcare workers showing its importance - e.g. by cleaning their own hands in the presence of the patient Through caregivers giving permission for patient to ask about hand hygiene Through a media campaign explaining the facts and encouraging involvement Through education in schools and colleges Through hospital campaigning Through clinics or other healthcare facilities actively promoting the importance of hand hygiene Through the involvement of Community/Country leaders Through visual aids or prompts (i.e.posters) Page 5 of 18
Personal experiences of health-care associated infections Graph 6: Do you know of anyone who acquired/caught an infection when they were in hospital, after surgery or visiting a clinic/office or any other healthcare facility?, and gave contact details, but did not wish to be contacted Response Graph 7: Do you know of anyone who acquired/caught an infection when they were in hospital, after surgery or visiting a clinic/office or any other healthcare facility, and which may have contributed to their death?, and gave contact details, but did not wish to be contacted Response Of the respondents who answered to these questions, 58 gave their contact details, and will be contacted during Phase 2 of the research for follow-up interviews. Page 6 of 18
Regional Analysis Respondents from 43 different countries completed the survey. For the purpose of regional analysis, the data will be divided into the World Health Organisation Regions: Region Number of Respondents Percentage The Americas (AMRO/PAHO) 144 61% Europe (EURO) 50 21% South East Asia and Western Pacific (SEARO and WPRO) 33 14% Africa and the Eastern Mediterranean (AFRO and EMRO) 10 4% One person did not state their country. For details of the number of respondents from each country, see Annex 1. The majority of the respondents were from the United Stages, Canada and the United Kingdom (92, 50, and 29 respectively). As there are only ten respondents at this stage from the AFRO and EMRO regions, this data can only serve as an initial indication, and for basic comparison between the regions. During Phase Two there will be an effort made to collect a greater proportion of responses from AFRO, EMRO, SEARO and WPRO. Availability of Hand Hygiene Products: Graph 8: Are hand cleaning materials (e.g. soap, water or alcohol-based handrubs) readily available for staff, patients, and visitors to use in your hospitals and clinics? 10 7 6 5 4 Response Sometimes 2 Total responses Worldwide AMRO EURO SEARO/WPRO AFRO/EMRO WHO Regions Page 7 of 18
Patient Empowerment Patient Experiences: Graph 9: Have you ever asked your healthcare worker to wash/sanitize their hands before they examined you? 10 7 6 5 4 Response 2 Total responses Worldwide AMRO EURO SEARO/WPRO AFRO/EMRO WHO Regions Patient expectations in hypothetical situations: Graph 10: If your doctor, nurse or other person providing healthcare to you, ASKED or invited you to remind them to wash/sanitize their hands before examining you, would you feel able to do this? 10 7 6 5 4 2 Response Total responses Worldwide AMRO EURO SEARO/WPRO AFRO/EMRO WHO Regions Page 8 of 18
Graph 11: If your doctor, nurse or other person providing healthcare to you, DID NOT ASK or invite you to remind them to wash/sanitize their hands before examining you, would you feel comfortable asking them to wash/sanitize their hands? 10 7 6 5 4 2 Response Total responses Worldwide AMRO EURO SEARO/WPRO AFRO/EMRO WHO Regions 10 Graph 12: If you saw your doctor or nurse taking care of the patient next to you and then coming to you without washing or sanitizing their hands, would you ask them to do so? 7 6 5 4 Response 2 Total responses Worldwide AMRO EURO SEARO/WPRO AFRO/EMRO WHO Regions Page 9 of 18
Hand Hygiene Programmes Graph 13: Does your COUNTRY have a programme that educates/communicates with patients about the importance of: 10 7 6 5 4 2 AMRO EURO SEARO/WPRO AFRO/EMRO AMRO EURO SEARO/WPRO AFRO/EMRO AMRO EURO SEARO/WPRO AFRO/EMRO Response Hand Hygiene Encouraging patients to ask about hand hygiene Any other aspect of the prevention of spread on infection Graph 14: Does your COMMUNITY have a programme that educates/communicates with patients about the importance of: 10 7 6 5 4 2 Response AMRO EURO SEARO/WPRO AFRO/EMRO AMRO EURO SEARO/WPRO AFRO/EMRO AMRO EURO SEARO/WPRO AFRO/EMRO Hand Hygiene Encouraging patients to ask about hand hygiene Any other aspect of infection control Page 10 of 18
Propotion of people from each region who selected this option (as a percentage of the total options selected for each region) 20 18 16 14 12 10 8 6 4 2 0 Graph 15: What would be the best way(s) to get messages across to educate people in your country/community about hand hygiene and how to prevent infection? Through healthcare workers showing its importance - e.g. by cleaning their own hands in the presence of the patient Through caregivers encouraging permission for patient to ask about hand hygiene Through a media campaign explaining the facts and encouraging involvement Through education in schools and colleges Through hospital campaigning Through clinics or other healthcare facilities actively promoting the importance of hand hygiene Through the involvement of Community/Country leaders Through visual aids or prompts (i.e.posters) AMRO EURO SEARO/WPRO AFRO/EMRO The data is presented as a percentage of the total number of options marked as important in each region. The graph therefore indicates which approaches are considered most useful in each region, showing some differences between regions. This provides potentially useful data to inform future programmes in each region. Page 11 of 18
Personal experiences of health-care associated infections Graph 16: Do you know of anyone who acquired/caught an infection when they were in hospital, after surgery or visiting a clinic/office or any other healthcare facility? 10 7 6 5 4 Response, but did not wish to be contacted, and gave contact details 2 Total responses Worldwide AMRO EURO SEARO/WPRO AFRO/EMRO WHO Regions 10 Graph 17: Do you know of anyone who acquired/caught an infection when they were in hospital, after surgery or visiting a clinic/office or any other healthcare facility, and which may have contributed to their death? 7 6 5 4 Response, but did not wish to be contacted, and gave contact details 2 Total responses Worldwide AMRO EURO SEARO/WPRO AFRO/EMRO WHO Regions Page 12 of 18
Analysis by Sector Although a concerted effort was made to target patients a large percentage of respondents stated that they were healthcare workers. Table 4: Are you a Healthcare Worker? Number of Percentage respondents 131 55% 106 45% It could be assumed that respondents who identified themselves as healthcare workers may have a different experience of the healthcare sector, greater knowledge of what programmes were in place and greater willingness to discuss hand hygiene issues with healthcare workers. Graph 18: Have you ever asked your healthcare worker to wash/sanitize their hands before they examined you? 10 7 6 5 4 Response 2 Healthcare Worker t Healthcare worker This appears to be supported by the results which show that 4 of healthcare worker respondents had in the past asked their healthcare worker to wash/sanitize their hands, compared with only 25% of non-healthcare workers who had done so. It should also be borne in mind that many of those who completed the surveys were connected in some way with patient safety, as policy makers, patient advocates, or patients who are interested in the subject of patient safety, and had in some instances personal experience of hand hygiene improvement. It is likely that they are more informed about the dangers of low compliance with hand hygiene. Page 13 of 18
Patient expectations in hypothetical situations: Graph 19: If your doctor, nurse or other person providing healthcare to you, ASKED or invited you to remind them to wash/sanitize their hands before examining you, would you feel able to do this? 10 7 6 5 4 Response 2 Healthcare Worker t Healthcare worker Graph 20: If your doctor, nurse or other person providing healthcare to you, DID NOT ASK or invite you to remind them to wash/sanitize their hands before examining you, would you feel comfortable asking them to do so? 10 7 6 5 4 Response 2 Healthcare Worker t Healthcare worker Page 14 of 18
Graph 21: If you saw your doctor or nurse taking care of the patient next to you and then coming to you without washing or sanitizing their hands, would you ask them to do so? 10 7 6 5 4 Response 2 Healthcare Worker t Healthcare worker Page 15 of 18
Personal experiences of health-care associated infections Graph 22: Do you know of anyone who acquired/caught an infection when they were in hospital, after surgery or visiting a clinic/office or any other healthcare facility? 10 7 6 5 4 Response, but did not wish to be contacted, and gave contact details 2 Healthcare Worker t Healthcare worker Graph 23: Do you know of anyone who acquired/caught an infection when they were in hospital, after surgery or visiting a clinic/office or any other healthcare facility, and which may have contributed to their death? 10 7 6 5 4 Response, but did not wish to be contacted, and gave contact details 2 Healthcare Worker t Healthcare worker Page 16 of 18 Conclusion
It is clear that a wealth of valuable information has been obtained from Phase 1 of the work, and the WHO World Alliance for Patient Safety are indebted to the respondents who took the time to complete the survey and provide contact details. In an attempt to expand the pool of information on this subject which in itself requires further research, the WHO World Alliance for Patient Safety will commence Phase 2 in vember 2007, with results anticipated by early 2008. Phase 2 will be publicised more widely in a bid to increase responses from people from the AFRO, EMRO, SEARO and WPRO regions, and from non-health care workers. Page 17 of 18
Annex 1 The Number of Respondents from Each Country Divided by Regional Category Region Country Number of Respondents The Americas (AMRO) Argentina 1 Canada 50 Colombia 1 USA 92 TOTAL 144 Europe (EURO) Austria 1 Belgium 1 Croatia 1 Cyprus 1 Finland 1 Germany 2 Greece 1 Ireland 1 Italy 1 Moldova 1 Portugal 1 Slovenia 1 Sweden 3 Switzerland 4 Turkey 1 UK 29 TOTAL 50 South East Asia and Western Pacific (SEARO and WPRO) Bangladesh 2 Bhutan 2 India 4 Indonesia 2 Maldives 3 Myanmar 2 Thailand 1 Timor-L Este 2 Australia 8 Brunei Darussalam 1 Cambodia 1 China 3 Malaysia 1 Singapore 1 TOTAL 33 Africa and the Eastern Mediterranean (AFRO and EMRO) Liberia 1 Nigeria 1 Uganda 1 Zambia 1 Iran 1 Jordan 1 Pakistan 2 Saudi Arabia 1 Tunisia 1 TOTAL 10 Page 18 of 18